Nonoperative Management of Cervical Myelopathy

Rhee, John M.; Shamji, Mohammed F.; Erwin, W. Mark; Bransford, Richard J.; Yoon, S. Tim; Smith, Justin S.; Kim, Hee Jin; Ely, Claire G.; Dettori, Joseph R; Patel, Alpesh A.; Kalsi‐Ryan, Sukhvinder

doi:10.1097/brs.0b013e3182a7f41d

Cited by 129 publications

(77 citation statements)

References 12 publications

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“…One of the exceptions to this trend was in Japan, where the majority of the patients sustaining SCIs were over the age of 50 years 52. This is primarily due to early spinal degenerative changes, specifically OPLL, as well as an increased prevalence of congenital stenosis, causing a higher risk of SCI following a traumatic event 58. Degeneration of various components of the vertebra is common in the elderly population and may lead to narrowing of the spinal canal 59.…”

Section: Discussionmentioning

confidence: 99%

“…Degeneration of various components of the vertebra is common in the elderly population and may lead to narrowing of the spinal canal 59. In turn, these degenerative changes place people at a greater risk of suffering SCI following a fall or another traumatic event 58. Therefore, with the aging of the population, acute care systems may be confronted with an increased number of elderly patients with SCI and should plan and allocate resources accordingly 59…”

Section: Discussionmentioning

confidence: 99%

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Global prevalence and incidence of traumatic spinal cord injury

Singh¹,

Tetreault²,

Kalsi-Ryan³

et al. 2014

CLEP

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499

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BackgroundSpinal cord injury (SCI) is a traumatic event that impacts a patient’s physical, psychological, and social well-being and places substantial financial burden on health care systems. To determine the true impact of SCI, this systematic review aims to summarize literature reporting on either the incidence or prevalence of SCI.MethodsA systematic search was conducted using PubMed, MEDLINE, MEDLINE in process, EMBASE, Cochrane Controlled Trial Register, and Cochrane Database of Systematic Reviews to identify relevant literature published through June 2013. We sought studies that provided regional, provincial/state, or national data on the incidence of SCI or reported estimates of disease prevalence. The level of evidence of each study was rated using a scale that evaluated study design, methodology, sampling bias, and precision of estimates.ResultsThe initial search yielded 5,874 articles, 48 of which met the inclusion criteria. Forty-four studies estimated the incidence of SCI and nine reported the prevalence, with five discussing both. Of the incidence studies, 14 provided figures at a regional, ten at a state or provincial level and 21 at a national level. The prevalence of SCI was highest in the United States of America (906 per million) and lowest in the Rhone-Alpes region, France (250 per million) and Helsinki, Finland (280 per million). With respect to states and provinces in North America, the crude annual incidence of SCI was highest in Alaska (83 per million) and Mississippi (77 per million) and lowest in Alabama (29.4 per million), despite a large percentage of violence injuries (21.2%). Annual incidences were above 50 per million in the Hualien County in Taiwan (56.1 per million), the central Portugal region (58 per million), and Olmsted County in Minnesota (54.8 per million) and were lower than 20 per million in Taipei, Taiwan (14.6 per million), the Rhone-Alpes region in France (12.7 per million), Aragon, Spain (12.1 per million), Southeast Turkey (16.9 per million), and Stockholm, Sweden (19.5 per million). The highest national incidence was 49.1 per million in New Zealand, and the lowest incidences were in Fiji (10.0 per million) and Spain (8.0 per million). The majority of studies showed a high male-to-female ratio and an age of peak incidence of younger than 30 years old. Traffic accidents were typically the most common cause of SCI, followed by falls in the elderly population.ConclusionThis review demonstrates that the incidence, prevalence, and causation of SCI differs between developing and developed countries and suggests that management and preventative strategies need to be tailored to regional trends. The rising aging population in westernized countries also indicates that traumatic SCI secondary to falls may become an increasing public health challenge and that incidence among the elderly may rise with increasing life expectancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Global prevalence and incidence of traumatic spinal cord injury

Singh¹,

Tetreault²,

Kalsi-Ryan³

et al. 2014

CLEP

Self Cite

499

296

View full text Add to dashboard Cite

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“…There are no studies in the literature that favor surgery over conservative treatment in mild CSM or vice versa [22] ( Table 1). Kadanka et al [13,14] addressed this question in their prospective study.…”

Section: Discussionmentioning

confidence: 99%

“…A well-designed prospective study is needed to make decisions based on stronger evidence. Rhee JM et al [22] Paucity of evidence in favor of non-operative treatment Kadaňka Z et al [13] No evidence to favor one treatment over the other; low number of patients for final evaluation Kadaňka Z et al [14] No substantial difference between the two treatment groups; short follow up period (2 years)…”

Section: Discussionmentioning

confidence: 99%

Considerations for Prophylactic Surgery in Asymptomatic Severe Cervical Stenosis

et al. 2015

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Background: Cervical spondylotic myelopathy (CSM) is a devastating pathology that can severely impair quality of life. The symptoms in CSM progress slowly and often do not manifest until they become severe and potentially irreversible. There is a consensus that surgical intervention is warranted in symptomatic patients. The recovery of the neurologic deficit after surgical decompression of the spinal cord varies, and halting the progression of the disease remains the principle aim of surgery. Questions/Purposes: The aim of this review is to address the key question of whether or not to intervene in cases that have radiographic evidence of significant cervical stenosis yet are asymptomatic or exhibit minimal symptoms? Methods: The PubMed databases for publications that addressed asymptomatic cervical spondylotic myelopathy were reviewed. The relevant articles were selected after screening all the resulting abstracts. The references of the relevant articles were then reviewed, and cross references with titles discussing CSM were picked up for review. Results: The search identified 14 papers which were reviewed. Seven articles were found to be relevant to the subject in question. Going through the references of the relevant articles, three articles were found to be directly related to the topic in study. Conclusion: There is paucity of evidence to support for or against surgery in the setting of asymptomatic cervical spondylotic myelopathy despite radiographic evidence of severe stenosis. Patient factors such as age, level of activity, and risk of injury should be considered in formulating a management plan. Moreover, the patient should play an integral role in the process of decision making.

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“…The mainstay of treatment for cervical myelopathy has involved surgery because conservative management may only be applicable to mild stenosis and has not generally been considered to be effective in moderate to severe stenosis. 14,16,18 However, many surgical options exist, including anterior decompression and fusion, posterior laminoplasty, posterior laminectomy and fusion, and/or combined surgery. 12,21 Levels of compression and the maintenance of cervical lordosis have been considered to be two important parameters for the selection of appropriate procedures.…”

mentioning

confidence: 99%

A novel technique to correct kyphosis in cervical myelopathy due to continuous-type ossification of the posterior longitudinal ligament

Lee¹,

Joo²,

Hwang³

et al. 2017

SPI

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OBJECTIVE Although posterior decompressive surgery is widely used to treat patients with cervical myelopathy and multilevel ossification of the posterior longitudinal ligament (OPLL), a poor outcome is anticipated if the sagittal alignment is kyphotic (or K-line negative). Accordingly, it is mandatory to perform anterior decompression and fusion in patients with cervical kyphosis. However, it can be difficult to perform anterior surgery because of the high risk of complications. This present report proposes a novel “greenstick fracture technique” to change the K-line from negative to positive in patients with cervical myelopathy, OPLL, and kyphotic deformity. METHODS Four patients with cervical myelopathy, continuous-type OPLL, and kyphotic sagittal alignment (who were K-line negative) were indicated for surgery. Posterior laminectomy and lateral mass screw insertions using a posterior approach were performed, followed by anterior surgery. Multilevel discectomy and thinning of the OPLL mass by bur drilling was performed, then an intentional greenstick fracture at each disc level was made to convert the cervical K-line from negative to positive. Finally, posterior instrumentation using a rod was carried out to maintain cervical lordosis. RESULTS MRI showed complete decompression of the cord by posterior migration in all cases, which had been caused by cervical lordosis. Restoration of neurological defects was confirmed at the 1-year follow-up assessment. No specific complications were identified that were associated with this technique. CONCLUSIONS A greenstick fracture technique may be effective and safe when applied to patients with cervical myelopathy, continuous-type OPLL, and kyphotic deformity (K-line negative). However, further studies with more cases will be required to reveal its generalizability and safety.

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Nonoperative Management of Cervical Myelopathy

Abstract: Weak.

Cited by 129 publications

References 12 publications

Global prevalence and incidence of traumatic spinal cord injury

Global prevalence and incidence of traumatic spinal cord injury

Considerations for Prophylactic Surgery in Asymptomatic Severe Cervical Stenosis

A novel technique to correct kyphosis in cervical myelopathy due to continuous-type ossification of the posterior longitudinal ligament

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